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DMST 295 Abdomen 2 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What is the shape of the thyroid?

A

Butterfly shape

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2
Q

Where is the thyroid located?

A

Based of the neck

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3
Q

How many lobes of they thyroid are there?

A

2 lobes (LT and RT)

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4
Q

Are they thyroid encapsulated?

A

Yes

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5
Q

Thyroid cartilage is related to which ring?

A

5th/ 6th ring

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6
Q

The thyroid can sometimes be a _________ __________: which is what?

A
  1. Pyramid lobe
  2. Fetal remnant, extends cranial from isthmus
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7
Q

What is the size and shape of the thyroid?

A

Variable but
1. Length: 4-6
2. AP: 2CM most precedes
3. Width 2 cm
4. Isthmus: 2-6 mm

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8
Q

Label the image

A
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9
Q

Label the structures

A
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10
Q

How vascular is the thyroid?

A

Very

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11
Q

What supply’s the RT and LT superior thyroid arteries?

A

ECA

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12
Q

What supplies blood to the RT and LT inferior thyroid arteries?

A

Subclavian artery branch

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13
Q

What are the three veins of the thyroid?

A
  1. Superior
  2. Middle
  3. Inferior
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14
Q

What is the lymph drainage for the thyroid?

A

Deep cervical nodes around carotids

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15
Q

What is the most common site for thyroid CA to metastasize?

A

Cervical nodes around carotids

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16
Q

What is the sonographic appearance of the thyroid? 3

A
  1. Homogenous
  2. Medium level echoes
  3. Hyper echoic thin capsules
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17
Q

What does this image demonstrate?

A

The esophagus

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18
Q

Label the image

A
  1. Colloid in lumen of follicle
  2. Parafollicular “C” cell
  3. Follicular cell
  4. Follicle
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19
Q

What kind of gland is the thyroid gland?

A

Endocrine gland

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20
Q

What does the thyroid do? What does it produce? 3

A
  1. Synthesize, stores, secretes hormones
  2. Regulates body metabolism
  3. Produces T3, T4, and calcitonin
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21
Q

What does T3 and T4 do?

A

Affect metabolic rate

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22
Q

What chemical helps synthesize T3 and T3?

A

Iodine

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23
Q

What does Calcitonin do?

A

Maintains homeostasis of blood calcium

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24
Q

How does calcitonin do what it needs to do? What does it act on?

A
  1. Decrease concentration of blood calcium
  2. Acts on bone > inhibits breakdown
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25
Q

What thyroid hormone does the hypothalamus release?

A

TRH

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26
Q

What thyroid hormone does the pituitary gland release?

A

TSH

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27
Q

How does the hypothalamus affects the pituitary gland?

A

When there is low blood levels of thyroid hormones the Hypothalamus releases TRH to pituitary so that it can release TSH to the thyroid follicle

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28
Q

What can affect thyroid hormone levels in blood?

A

Thyroid disease

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29
Q

What are three kinds of thyroid diseases or states?

A
  1. Euthyroid
  2. Hypothyroid
  3. Hyperthyroid
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30
Q

What is hypothyroidism?

A
  1. Under secretion of thyroid hormones
  2. Body metabolism decreases
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31
Q

What is hypothyroidism related to? 3 (what causes it)

A
  1. Low intake of iodine
  2. Dysfunction of gland
  3. Pituitary gland abnormality
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32
Q

What are some signs/ symptoms of hypothyroidism? 5

A
  1. Weight gain
  2. Hair loss
  3. Lethargy
  4. Cold intolerance
  5. Husky voice
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33
Q

What are some causes of hypothyroidism? 4

A
  1. Hashimoto’s - most common in N.A
  2. Iodine deficiency - worldwide
  3. Partial thyroid echo my
  4. Pituitary gland problems
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34
Q

What is hyperthyroidism?

A
  1. Overproduction of thyroid hormones
  2. Body metabolism increases
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35
Q

What is hyperthyroidism related to? 2

A
  1. Entire thyroid gland over functioning
  2. Neoplasm
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36
Q

What are some signs/ symptoms of hyperthyrodism? 6

A
  1. Weight loss, increased appetite
  2. Nervousness
  3. Sweating, heat intolerance
  4. Palpitation
  5. Fatigue
  6. Exophtalmos
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37
Q

What are some causes of hyperthyrdism? 5

A
  1. Graves’ disease (with a goiter)
  2. Toxic adenomas
  3. Inflammation of thyroid
  4. Excessive thyroid medication
  5. Pituitary tumour
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38
Q

What are some lab tests for thyroids? 4

A
  1. T3
  2. T4
  3. TSH
  4. Thyroid antibodies (autoimmune disorders)
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39
Q

What is/are other tests we do besides the hormone thyroid tests? What does it determine? How is it given? What do the two results mean?

A

Nuc med
1. Determines function
2. Radioisotope given to patient
3. Hot nodules > hyper functioning > Benign
4. Cold nodules > Non functioning > possible malignancy

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40
Q

What are some indications for thyroid scans? 4

A
  1. Increase in gland size (symmetric or asymmetric)
  2. Change in metabolism
  3. Nuclear medical scan - Cold nodule
  4. Palpable lump
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41
Q

How do we prepare to scan the thyroid? 5

A
  1. Obtain patient history
  2. Place patient in a supine position
  3. Elevate the shoulders slightly
  4. Neck minimally hyperextended
  5. Physical assessment
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42
Q

What do we do for a physical assessment when preparing for a thyroid scan for palpable masses?

A
  1. Request that the patient localize the palpable mass
  2. Once located, request permission to touch the patient and palpate the mass
  3. If consent is given, Palpate the region of interest
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43
Q

What kind of probe do we use for a thyroid scan?

A

High frequency linear probe

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44
Q

What are some benign focal diseases in the thyroid? 3

A
  1. Cysts
  2. Thyroglossal duct cysts
  3. Adenoma
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45
Q

How common are true cysts in the thyroid?

A

Uncommon

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46
Q

Commonly ____ ________ of a follocular adenoma is seen in the thyroid

A
  1. Cystic degeneration
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47
Q

When would we have hemorrhagic cysts in the thyroid? And what are they?

A
  1. When we receive blunt trauma to neck
  2. Acute hemorrhage of adenoma
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48
Q

What is the sonographic appearance of a simple cyst?

A

Anechoic

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49
Q

What is the sonographic appearance of a complex cyst?

A
  1. Internal Echoes
  2. Irregular wall
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50
Q

What is the sonographic appearance of a colloid cyst?

A

Echogenic focci with comet tail

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51
Q

What does this image demonstrate?

A

Colloid cyst

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52
Q

What kind of abnormality is a thyroglossal duct cyst?

A

Congenital abnormality

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53
Q

Where is thyroglossal duct found? 2

A
  1. Midline of neck
  2. Anterior to trachea
54
Q

What is a thyroglossal duct cyst?

A

Failure of tract to atrophy (base of tongue to isthmus)

55
Q

What kind of structure is a thyroglossal duct cyst? How big is it?

A
  1. Fusiform cystic structure
  2. less than 3cm
56
Q

What is this an image of?

A

Thyroglossal duct cyst

57
Q

Which demographic is more likely to develop an adenoma?

A

Women > Men

58
Q

Is adenoma something to worry about?

A

They are generally benign

59
Q

What is the most common type of adenoma?

A

Follicular adenoma

60
Q

With Nuclear Medicine test how does adenoma’s present?

A
  1. Asymptomatic
  2. Typically cold nodule
61
Q

How fast do adenoma’s grow?

A

They are slow growing and variable in size

62
Q

What is the sonographic appearance of a adenoma? 6

A
  1. Anechoic > ISO > Hyper
  2. Solitary
  3. Defined
  4. Round/ Oval
  5. Hypoechoic halo
  6. Eggshell calcification
63
Q

What does this image demonstrate?

A

Adenoma

64
Q

What are some benign diffuse disease? How do we determine these? 3

A
  1. Inflammation (Thyroiditis)
  2. Hyperplasia (Goiter)
  3. Diagnosis based on clinical and lab findings
65
Q

What is thyroiditis? and who is most likely affected

A
  1. Inflammation and fever
  2. Swelling and tenderness of the gland
  3. Middle- aged women
66
Q

What diseases are related to thyroiditis? 5

A
  1. Hashimoto’s
  2. Acute suppurative
  3. Subacute granulomatous
  4. Silent
  5. Invasive fibrous (Reidel’s)
67
Q

What is Hashimoto’s disease? What kind of disease is it? How painful is it? What kind of antibodies is seen with it? 4

A
  1. Chronic lymphocytic inflammation disease
  2. Autoimmune
  3. Typically painless
  4. Antithyroid antibodies
68
Q

What is the most common form of Hashimoto’s?

A

Adult hypothyroidism

69
Q

If one has Hashimoto’s they have an increased risk of what?

A

Lymphoma

70
Q

Which demographic is typical affected with Hashimoto’s ?

A

Women

71
Q

What does Hashimoto’s look like sonographically? 7

A
  1. Diffusely enlarged
  2. Heterogeneous
  3. Hypoechoic
  4. Possible discrete nodules or calcifications
  5. Difficult to differentiate from MNG
  6. May be hyper vascular (acute stages), but vascularity typically normal or decreased
  7. Cervical lymphadenopathy
72
Q

What does this image demonstrate?

A

Hashimoto’s

73
Q

What is acute suppurative thyroiditis? What is it typically caused by?

A
  1. Firm painful thyroid
  2. Bacterial infection
74
Q

What are some signs for acute supportive thyroiditis?2

A
  1. Low grade fever
  2. Sore throat
75
Q

How common is acute suppurative thyroiditis? Who is the most common demographic impacted?

A

Children

76
Q

What does this image demonstrate?

A

Acute suppurative thyroiditis, Note the

  1. Enlargement
  2. Hypoechoic
  3. Possible abscess
77
Q

What is silent thyroiditis?

A

Enlarged gland with no pain

78
Q

What does silent thyroiditis resemble?2

A
  1. Hashimoto’s
  2. Clinically: Subacute granulomatous
79
Q

What is invasive fibrous (Riedel’s struma)? What does it look like? How can it affect the extra thyroid?

A
  1. Typically complete destruction of gland
  2. Enlarged heterogeneous thyroid
  3. Inflammatory process can extend extra thyroid
80
Q

What is the rarest form of thyroiditis?

A

Invasive fibrous (Riedel’s Struma)

81
Q

What is hyperplasia? 4 (of the thyroid)

A
  1. Goiter
  2. Diffuse enlargement of the thyroid
  3. Palpable gland
  4. +/- functional disturbance
82
Q

What are some causes for hyperplasia? 2

A
  1. Iodine deficiency
  2. Defect in normal hormone synthesis
83
Q

How long does it take for hyperplasia to manifest?

A

typically years to manifest

84
Q

What are some disease that are related to hyperplasia? 3

A
  1. Graves disease
  2. Nontoxic goiter
  3. Multinodular goiter
85
Q

What is graves disease?2

A
  1. Autoimmune disorder
  2. Diffuse toxic goiter
86
Q

What are some signs and symptoms of Grave’s disease? 4

A
  1. Hyperthyroidism
  2. Exophthalmos
  3. Skin thickening
  4. Clubbed toes and fingers
87
Q

Which demographic is generally affected by Grave’s disease?

A
  1. Women > Men
  2. 30 - 40 years of age
88
Q

What does graves disease look like sonographically?5

A
  1. Diffuse symmetrical enlargement
  2. Lobulated
  3. Homogenous or heterogeneous
  4. Hypoechoic
  5. “Thyroid inferno”
89
Q

What does this image demonstrate?

A

Grave’s disease

90
Q

What is a non-toxic goiter?

A
  1. Endemic or sporadic goiter
  2. No functional disturbances
91
Q

What causes a non-toxic goiter?

A

Lack of iodine in diet

92
Q

How fast does non-toxic goiters grow?

A

Slow

93
Q

What does non-toxic goiters look like on ultrasound?

A
  1. Diffusely and uniformly enlarged
  2. Smooth or nodular echotexture
  3. Typically not as large as MN goiters
94
Q

What is a Multinodular goiter?

A

Adenomatous goiter

95
Q

What causes multi-nodular goiters?

A

Due to iodine deficiency > deficiency of thyroid hormone production > TSH from pituitary stimulates thyroid > Thyroid enlargement

96
Q

Which demographic of individuals is most likely affected by Multinodular goiters?

A

Females aged 50-70

97
Q

What does Multinodular goiters look like sonographically? 4

A
  1. Enlarged often asymmetrical
  2. Diffusely heterogenous
  3. Multiple discrete nodule
  4. Calcifications
  5. Cystic areas
98
Q

What does this image demonstrate?

A

Multinodular Goiter

99
Q

What are malignant lesions?

A

Solitary nodules more worrisome than multiple

100
Q

What is the common demographic affected with malignant lesions?

A
  1. Women > Men
  2. 40-60 years old
101
Q

How fast does malignant lesions grow?

A

Slow

102
Q

Was is needed for analysis for Malignant lesions?

A

FNA needed for diagnosis; no sonographic feature is sensitive or specific enough

103
Q

How does the patient present with Malignant lesions? 3

A
  1. Pressure symptoms (difficulty breathing or swallowing)
  2. Painless, palpable neck mass
  3. Hoarseness
104
Q

What is the sonographic appearance of malignant lesions? 8

A
  1. Variable appearance
  2. Often Hypoechoic
  3. Poorly defined boarders
  4. Jagged boarders
  5. Absence of halo
  6. Microcalcifications
  7. Taller than wide
  8. Enlarged nodes
105
Q

What are some thyroid cancers? 6

A
  1. Papillary
  2. Follicular
  3. Medullary
  4. Anaplastic
  5. Lymphoma
  6. Metastases
106
Q

Are papillary carcinomas asymptomatic or symptomatic? How fast do they grow?

A
  1. Asymptomatic
  2. Slow growing, may spread to cervical lymph nodes
107
Q

Which demographic of individuals are affected by papillary carcinoma?

A

Females > males

108
Q

Which is the most common/ least aggressive thyroid cancer?

A

Papillary carcinoma by 60- 70%

109
Q

What does this image demonstrate?

A

Papillary Cancer, note the

  1. Solid
  2. Hypoechoic
  3. Microcalcifications
  4. Tiny to 10 cm
  5. Hypervascularity
110
Q

Follicular carcinomas grow how fast and how aggressive are they compared to papillary? Do they metastasize from somewhere? If they do where from?

A
  1. Slow growing but more aggressive than papillary carcinoma
  2. Metastases to lung and bone via blood
111
Q

What are the occurrence rate follicular carcinoma?

A

15- 20%

112
Q

What is the demographic of individuals affected by follicular carcinoma?

A
  1. Female > males
  2. 40-50 years
113
Q

What increases the risk of follicular carcinoma?

A

history of radiation to thyroid risk factor

114
Q

What does follicular carcinoma look like sonographically? 5

A
  1. Appearance of an adenoma
  2. Enlarging encapsulated nodule
  3. Irregular boarders
  4. Thick halo
  5. Microcalcifications
115
Q

What is the demographic of individuals that are affect by Medullary carcinoma?

A

Men and women equally

116
Q

What is medullary carcinoma?

A
  1. Hard bulky mass
  2. Metastasize readily
117
Q

What does the medullary carcinoma secrete?

A

Calcitonin

118
Q

How many cases are related to medullary carcinomas?

A

5%

119
Q

What does medullary carcinomas look like sonographically? 5

A
  1. Solid
  2. Hypoechoic
  3. Well-circumscribed
  4. Encapsulated
  5. Coarse Calcifications
120
Q

What is anaplastic carcinoma? Patients are at risk of what?

A
  1. Aggressive invasion of adjacent structures
  2. Death by compression/ Asphyxiation
121
Q

What is the most rarest and most aggressive carcinoma?

A

Anaplastic carcinoma

122
Q

Who is most affected by anaplastic carcinoma?

A

Common in older patients >60 years

123
Q

What does anaplastic carcinoma look like sonographically? 4

A
  1. Hypoechoic, solid
  2. Irregular
  3. Encase or invade blood vessels
  4. Invade neck muscles
124
Q

What is Lymphoma?

A
  1. Rapidly growing mass
  2. Hypoechoic, lobular, non vascular
  3. Most non- Hodgkins
125
Q

Which demographic of individuals are affected by Lymphoma? What do they have a history of typically? What is the most common variation?

A
  1. Most non- hodgkin’s
  2. Older females
  3. History of hashimotos
126
Q

What is matastases frequency? What is the route? Which tissues? 3

A
  1. Infrequent
  2. Hematogenous route
  3. From breast, lung, colon, melanoma
127
Q

About _____ % of patients with systemic lymphoma have ______ __________.

A
  1. 20%
  2. Thyroid involvement
128
Q

Label the structures

A
129
Q

What is the criteria for a benign thyroid lesion? 5

A
  1. Regular, well defined borders
  2. Thin, Hypoechoic halo
  3. Solitary or multiple minute cysts within mass
  4. Hyperechoic
  5. Large calcifications, especially around the periphery
130
Q

What is the criteria for a malignant thyroid lesion? 3

A
  1. Irregular border
  2. Absence of a halo
  3. Macrocalcifications

DMST 295 Abdomen 2 (8 decks)

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